In-water Recompression

These papers are more general reviews of the topics listed and have been selected based on searches of the Rubicon Research Repository (RRR) and questions found in online forums. They are meant to serve as a starting point for anyone interested in the contents of our collection. This is by NO means an exhaustive search or list of categories. We will continue to build on this resource as we have time so please check back with us.

DISCLAIMER: The Rubicon Foundation only serves to pass along published information and does not endorse or recommend any of the methods, equipment or procedures found on this page.

Treatment of decompression sickness (DCS) utilizing the US Navy Treatment Table 6 with oxygen at 18m is a standard of care (1). Significant delay to treatment, difficult transport, and facilities with limited experience may lead one to consider on site treatment (2). Surface oxygen for first aid has been proven to improve the efficacy of recompression and decreased the number of recompression treatments required when administered within four hours post dive (3). In-water recompression (IWR) to 9 m breathing oxygen is one option that has shown success over the years (4, 5, 6). IWR is not without risk and should be undertaken with certain precautions (4, 7, 8, 9).

Six IWR treatment tables have been published in the scientific literature. Each of these methods have several commonalities including the use of a full face mask, a tender to supervise the diver during treatment, a weighted recompression line and a means of communication. The history of the three older methods for providing oxygen at 9m (30 fsw) was described in great detail by Drs. Pyle and Youngblood (4). The fourth method for providing oxygen at 7.5 m (25 fsw) was described by Pyle at the 48th Annual UHMS Workshop on In-water Recompression in 1999 (8). More recent is the development of the Clipperton and Clipperton-(a) methods for use on a scientific mission to the atoll of Clipperton, 1,300 km from the Mexican coasts. The Clipperton method involves recompression to 9m (30 fsw) while the Clipperton-(a) rebreather method involves a recompression to 30m (98 fsw) (10).

Brief History and Risks (9, 11)

The Royal Australian Navy School of Underwater Medicine was charged to supervise the then, non-sanctioned, practice of IWR. This charge was in response to the very long delays that were associated between the presentation of DCS and recompression treatment. Dr Edmonds also described the debates about underwater oxygen treatment for DCS that are not unlike current concerns.
* Inappropriate cases for treatment
* Oxygen Toxicity
* Emergency Termination of Treatment
* Hypothermia
* Adequacy of Equipment in Remote Areas
* Seasickness
* Operator Expertise and Training
* Safety of the Diving Attendant and the Boat Tenders
* Requirement for Medical Supervision
* Transport Availability
* Misuse of Equipment
* Pulmonary Barotrauma Cases

4. Pyle and Youngblood. (1997) In-water Recompression as an emergency field treatment of decompression illness. SPUMS Journal Volume 27 Number 3. RRR ID: 6083 (NOTE: A version of this paper was originally published in aquaCorps 1995; Number 11, UNDERGROUND XPLORERS:35-46 without references.)

Smith, Hardman, and Beckman. (1994) Immediate in water recompression – Does it make a difference in the pathology of central nervous system decompression sickness? RRR ID: 5632 Note: UHMS abstract, no paper available